Robotic Thyroidectomy Versus Nonrobotic Approaches

Abstract

Background Robotic surgery has been recently used as a novel tool for remote access thyroid surgery. We performed a meta-analysis of the current literature to examine the safety and oncological efficacy of robotic surgery compared to endoscopic and conventional approaches for different thyroid procedures. Methods A systematic search of the online data bases was done using the following (MeSH) terms "robotic surgery," "robotic thyroidectomy," "robot-assisted thyroidectomy," and "robot-assisted thyroid surgery." Outcomes measured included total operative time, length of hospital stay, postoperative thyroglobulin levels, and postoperative complications. Statistical differences were analyzed between groups through the standard means and/or relative risk by using STATA analytical software. Results In this study, 144 articles were identified; of which 18 of them met our inclusion criteria, totaling 4878 patients. Robotic approach was associated with longer total operative time (mean difference of 43.5 minutes) when compared to the conventional cervical approach (95% CI = 20.9-66.2; P < .001). Robotic approach was also found to have a similar risk of total postoperative complications when compared to the conventional and endoscopic approaches. Conclusion Robotic thyroid surgery is as safe, feasible and provides similar periperative complications and oncological outcomes when compared to both, conventional cervical and endoscopic approaches. However, robotic thyroid surgery is associated with longer operative time when compared to the conventional open approach.

Robotic Thyroid Surgery: Current Perspectives and Future Considerations

“…In terms of oncological efficacy, there are several recent systematic reviews and meta-analyses pooling data from studies collectively reporting on several thousand cases that illustrate that there is no significant difference between the robotic and open approaches in terms of serum thyroglobulin levels, post-ablation radioactive iodine scan uptake, lymph node yield, locoregional recurrence and survival rates, thus confirming the oncological value of robotic thyroidectomy for differentiated thyroid cancer (level 2a) [13, 21, 25, 26]. …”

“…No significant differences between robotic and open thyroidectomy in terms of transient and permanent recurrent laryngeal nerve injury, permanent hypoparathyroidism, or haemorrhage were identified (level 2a) [16, 21-24]. A higher incidence of transient hypoparathyroidism was detected in robotic thyroidectomy patients (level 2a) [16, 21]. …”

“…On the other hand, early swallowing and scar satisfaction showed a significant benefit consistently favouring the robotic approach (level 2a) [21, 25]. …”

Tiroides ectópica dual hiperfuncionante: Abordaje quirúrgico dual

“…Actualmente la mayor experiencia con estas técnicas se ha reportado en Corea del Sur. Se han encontrado tasas de complicaciones habituales similares a las de la tiroidectomía clásica (abierta) y complicaciones inusuales (fístula del quilo, lesión traqueal, lesión carotidea, síndrome de Horner) similares a la tiroidectomía clásica 57,58 .…”

“…En estudios recientes se ha debatido y se ha extendido la aplicación de las técnicas mínimamente invasivas para el manejo de las neoplasias tiroideas. Los estudios más recientes describen el uso de esta técnica en microcarcinomas de tiroides 71,72 con tasas de recuento ganglionar comparables con la técnica abierta cuando se realiza vaciamientos centrales 73 y radicales modificados 74 . En el momento no hay estudios publicados de esta técnica mínimamente invasiva con seguimientos a largo plazo para definir los resultados oncológicos 75,76 .…”